光学相干断层成像下吸烟对年轻急性冠状动脉综合征患者斑块特征的影响

摘要

Objective To explore the impact of smoking on coronary plaque characteristics on optical coherence tomography(OCT) in young patients with acute coronary disease(ACS).Methods We assessed the atherosclerotic plaque characteristics and vulnerability by OCT and coronary angiography in 60 ACS patients aged 45 years or younger in Beijing Anzhen Hospital, from June 2014 to June 2017. The patients were divided into the smoking group(n=33) and the non-smoking group(n=27) to compare the plaque characteristics and vulnerability.Results Smoking patients showed a less extent of fibrosis(48.55％vs. 77.8％,P=0.032)and microchannels(18.2％vs. 44.4％,P=0.033), and a greater extent of plaque rupture (24.2％vs. 3.7％,P=0.033) compared with non-smoking patients. In multivariate analysis, smoking was the only independent predictors of plaque rupture(OR 8.320, 95％CI 0.969-71.435,P=0.027) and less fibrosis (OR 0.269, 95％CI 0.086-0.837,P=0.020). Conclusions Patients who are smokers have less extensive fibrosis and a greater extent of plaque rupture, showing more extensive vulnerable plaque phenotype. Therefore, smoking is one of the major risk factors of advanced cardiovascular events in young patients.%目的 通过使用光学相干断层成像(optical coherence tomography,OCT)探究吸烟的年轻急性冠状动脉综合征(acute coronary syndrome,ACS)患者冠状动脉斑块特征.方法 纳入北京安贞医院2014年6月至2017年6月因ACS入院行OCT且年龄≤45岁的60例患者,根据是否吸烟将患者分为吸烟组(33例)和非吸烟组(27例),通过冠状动脉造影及OCT对患者冠状动脉的狭窄程度及斑块特征进行分析,比较两组患者的斑块特征及斑块易损性.结果 吸烟组罪犯病变斑块处纤维增生(48.5％比77.8％,P=0.032)及微通道(18.2％比44.4％,P=0.046)的发生率低于非吸烟组,差异均有统计学意义;斑块破裂发生率高于非吸烟组(24.2％比3.7％,P=0.033),差异有统计学意义.二元logistic多变量回归分析显示,吸烟是发生斑块破裂的独立预测因素(OR 8.320,95％CI 0.969～71.435,P=0.027),高血压病(OR 0.301,95％CI 0.097～0.934,P=0.034)和吸烟(OR 0.269,95％CI 0.086～0.837,P=0.020)则是纤维增生的独立预测因子.结论 吸烟患者斑块处纤维增生较少,斑块易损性较高,更易发生斑块破裂.因此吸烟是导致年轻ACS患者发生不良心血管事件的主要危险因素之一.